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The Virginia Department of Health confirmed Wednesday that 55 Virginia residents have tested positive for hepatitis A associated with the contaminated Tropical Smoothie Café strawberries from Egypt, including six from the Central Region, which includes Richmond.

An official with the Centers for Disease Control and Prevention also confirmed Wednesday that there were at least 11 confirmed cases in other states as of Tuesday afternoon. CDC spokeswoman Nora Spencer-Loveall said that, as of Tuesday afternoon, there were people with confirmed cases of hepatitis A in other states, including four in Maryland, four in West Virginia and one each in Oregon, North Carolina and Wisconsin.

As the Richmond Times-Dispatch reports, there are question about whether the Tropical Smoothie chain and state health officials responded quickly enough in removing contaminated strawberries and notifying the public of the danger. According to a health department official, it took Tropical Smoothie up to four days to get all of the Egyptian strawberries out of use in its 96 Virginia restaurants. The questions do not stop with the delay in removing the contaminated strawberries from the restaurants. It took Tropical Smoothie and the health department an additional two weeks to warn the public about the potential contamination.

Why is this delay in warning the public important? Some of the people who contracted hepatitis A may have been able to avoid contracting the liver disease by getting vaccines if they’d been notified sooner. The vaccines are typically effective within two weeks of exposure to the hepatitis A virus.

The health department notified Tropical Smoothie of its investigation into the chain’s frozen strawberries on August 5, 2016. Tropical Smoothie removed the contaminated strawberries from its store by August 9. The public was not notified until August 19. Customers exposed to the virus in late July – early August may have been saved from permanent liver disease had they been vaccinated in the first two weeks of August.

In public statements, the Virginia Department of Health and Tropical Smoothie characterize their response to this public health crisis as successful.

Symptoms of hepatitis A include yellowing of the skin or eyes, fever and nausea. Exposure occurs through direct contact with another person who has the infection or by consuming contaminated food or drink. Hepatitis A has caused death in comparatively few cases, and in some others people require liver transplants.

If you or someone close to you has these symptoms or is concerned about having been exposed to hepatitis A, consult a physician immediately. The Tropical Smoothie exposure in Virginia occurred between May and August 9, 2016. If you have been exposed to hepatitis A from a Tropical Smoothie drink containing strawberries, call us. We can help.